Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This week I read an interesting article by a physician about the huge challenges clinicians face coping with unthinkably large clinical data sets — and what we should do about it. The doctor who wrote the article argues for the creation of a next-gen clinician/health IT hybrid expert that will bridge the gaps between technology and medicine.

In the article, the doctor noted that while he could conceivably answer any question he had about his patients using big data, he would have to tame literally billions of data rows to do so.

Right now, logs of all EHR activity are dumped into large databases every day, notes Alvin Rajkomar, MD. In theory, clinicians can access the data, but in reality most of the analysis and taming of data is done by report writers. The problem is, the HIT staff compiling reports don’t have the clinical context they need to sort such data adequately, he says:

“Clinical data is complex and contextual,” he writes. “[For example,] a heart rate may be listed under the formal vital sign table or under nursing documentation, where it is listed as a pulse. A report writer without clinical background may not appreciate that a request for heart rate should actually include data from both tables.“

Frustrated with the limitations of this process, Rajkomar decided to take the EHR database problem on. He went through an intense training process including 24 hours of in–person classes, a four-hour project and four hours of supervised training to obtain the skills needed to work with large clinical databases. In other words, he jumped right in the middle of the game.

Even having a trained physician in the mix isn’t enough, he argues. Ultimately, understanding such data calls for developing a multidisciplinary team. Clinicians need each others’ perspectives on the masses of data coming in, which include not only EHR data but also sensor, app and patient record outcomes. Moreover, a clinician data analyst is likely to be more comfortable than traditional IT staffers when working with nurses, pharmacists or laboratory technicians, he suggests.

Still, having even a single clinician in the mix can have a major impact, Rajkomar argues. He contends that the healthcare industry needs to create more people like him, a role he calls “clinician-data translator.” The skills needed by this translator would include expertise in clinical systems, the ability to extract data from large warehouses and deep understanding of how to rigorously analyze large data sets.

Not only would such a specialist help with data analysis, and help to determine where to apply novel algorithms, they could also help other clinicians decide which questions are worth investigating further in the first place. What’s more, clinician data scientists would be well-equipped to integrate data-gathering activities into workflows, he points out.

The thing is, there aren’t any well-marked pathways to becoming a clinician data scientist, with most data science degrees offering training that doesn’t focus on a particular domain. But if you believe Rajkomar – and I do – finding clinicians who want to be data scientists makes a lot of sense for health systems and clinics. While their will always be a role for health IT experts with purely technical training, we need clinicians who will work alongside them and guide their decisions.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This quote from Andy Slavitt at Health Datapalooza has really stuck with me. He calls it the physician data paradox. It’s an ugly paradox and is at the heart of so many doctors discontent with EHR software. Andy Slavitt is spot on with his analysis. Doctors spend hours entering all of this data and get very little return value from that data or the volume of health data that is being captured.

My friend Dr. Michael Koriwchak has made an interesting request. In a recent blab interview he was on he said that CMS should only require the collection of data they’re actually going to use.

My guess is that the majority of meaningful use data would not need to be collected if Dr. Koriwchak’s rule was in place. CMS hasn’t really even collected the data from doctors, so they’re certainly not using it. Some of the principles of meaningful use would still exist like interoperability and ePrescribing, but we wouldn’t be turning our doctors into data entry clerks of data that’s not being used.

Think about the reality of meaningful use data collection: CMS doesn’t use the data. Clinicians don’t use the data.

We’ve basically asked doctors and other medical staff to spend millions of hours collecting a bunch of data that’s not being used. Does that make sense to anyone? You could make the argument that the data collection is creating a platform for the future. There’s some value in this thinking, but that’s pretty speculative spending. Why not do this type of speculative data collection with small groups who get paid for their efforts and then as they discover new healthcare opportunities? We can expand the data collection requirement to all of healthcare once doctors can do something meaningful with the data they’re being required to collect.

In fact, what if we paid docs for telling CMS or their EHR vendor how EHR data could be used to benefit patients? I’d see this similar to how IT companies pay people who submit bug reports. Not using health data the right way is kind of like reporting a bug in the health system. Currently, there’s no financial incentive for users to share their best practices and discoveries. Sure, some of them do it at user conferences or other conferences, but imagine how much more interested they’d be in finding and sharing health data discoveries if they were paid for it.

If we finally want to start putting all this health data to work, we’re going to have to solve the physician data paradox. Leveraging the power of the crowd could be a great way to improve the 2nd part of the paradox.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Shereese Maynard offered this interesting stat about the data inside an EHR and how that data is used.

It's estimated that less than 25% of info. gathered in EHR systems is useful in assessing & addressing health outcomes (Givens, 2016) #HITsm

It’s a tricky world we live in, but the above discussion is not surprising. EHRs were created to make an office more efficient (many have largely failed at that goal) and to help a practice bill at the highest level. In the US, you get paid based on how you document. It’s safe to say that EHR software has made it easier to document at a higher level and get paid more.

Notice that the goals of EHR software weren’t to improve health outcomes or patient care. Those goals might have been desired by many, but it wasn’t the bill of goods sold to the practice. Now we’re trying to back all this EHR data into health outcomes and improved patient care. Is it any wonder it’s a challenge for us to accomplish these goals?

When was the last time a doctor chose an EHR based on how it could improve patient care? I think most were fine purchasing an EHR that they believed wouldn’t hurt patient care. Sadly, I can’t remember ever seeing a section of a RFP that talks about an EHRs ability to improve patient care and clinical outcomes.

No, we store data in an EHR so we can improve our billing. We store data in the EHR to avoid liability. We store data in the EHR because we need appropriate documentation of the visit. Can and should that data be used to improve health outcomes and improve the quality of care provided? Yes, and most are heading that way. Although, it’s trailing since customers never demanded it. Plus, customers don’t really see an improvement in their business by focusing on it (we’ll see if that changes in a value based and high deductible plan world).

In my previous post about medical practice innovation, Dr. Nieder commented on the need for doctors to have “margin in their lives” which allows them to explore innovation. Medical billing documentation is one of the things that sucks the margins out of a doctor’s life. We need to simplify the billing requirements. That would provide doctors more margins to innovate and explore ways EHR and other technology can improve patient care and clinical outcomes.

In response to yesterday’s post about Virtual ACO’s, Randall Oates, MD and Founder of SOAPware (and a few other companies), commented “Additional complexity will not solve healthcare crises in spite of intents.” He, like I, fear that all of this value based reimbursement and ACO movement is just adding more billing complexity as opposed to simplifying things so that doctors have more margin in their lives to improve healthcare. More complexity is not the answer. More room to innovate is the answer.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been having a discussion around healthcare data with a lot of people recently. One person I talked with at MGMA says we need more filters with that data. I thought it was interesting that he used the word filters. I’m not sure it’s quite the right word since filters means you only look at part of the data. In healthcare we need something that looks at all the data, but only boils up the data that matters to the healthcare provider at the time and place they need it.

Unfortunately, I’ve seen most healthcare analytics and healthcare data companies focused on the data. I haven’t seen many of them really work on the intelligence (filters if you prefer) that’s needed on top of that data. Healthcare organizations need solutions. They don’t need more tools.

We all know why companies are providing tools as opposed to solutions. It’s much easier to build the tools. It’s much harder to discover and share the solutions. However, the reward is going to be massive for those organizations that provide solutions.

Going back to the original question: How do you plan to manage all the data? I think that most healthcare providers have no idea. I think they assume they’ll be able to purchase solutions that do the work for them. I’m not seeing many of those solutions yet, but I’m sure they’re coming.

The following is a guest blog post by Dr. Mike Zalis, practicing MGH Radiologist and co-founder of QPID Health.
Remember the “World Wide Web” before search engines? Less than two decades ago, you had to know exactly what you were looking for and where it was located in order to access information. There was no Google—no search engine that would find the needle in the haystack for you. Curated directories of URLs were a start, but very quickly failed to keep up with the explosion in growth of the Web. Now our expectation is that we will be led down the path of discovery by simply entering what’s on our mind into a search box. Ill-formed, half-baked questions quickly crystalize into a line of intelligent inquiry. Technology assists us by bringing the experience of others right to our screens.

Like the Internet, EHRs are a much-needed Web of information whose time has come. For a long time, experts preached the need to migrate from a paper-based documentation systems – aka old school charts—to electronic records. Hats off to the innovators and the federal government who’ve made this migration a reality. We’ve officially arrived: the age of electronic records is here. A recent report in Health Affairs showed that 58.9% of hospital have now adopted either a basic or comprehensive EHR—this is a four-fold increase since 2010 and the number of adoptions is still growing. So, EHRs are here to stay. Now, we’re now left to answer the question of what’s next? How can we make this data usable in a timely, efficient way?

My career as a radiologist spanned a similar, prior infrastructure change and has provided perspective on what many practitioners need—what I need—to make the move to an all-electronic patient record most useful: the ability to quickly get my hands on the patient’s current status and relevant past history at the point-of-care and apply this intelligence to make the best decision possible. In addition to their transactional functions (e.g., order creation), EHRs are terrific repositories of information and they’ve created the means but not the end. But today’s EHRs are just that—repositories. They’re designed for storage, not discovery.

20 years ago, we radiologists went through a similar transition of infrastructure in the move to the PACS systems that now form the core of all modern medical imaging. Initially, these highly engineered systems attempted to replicate the storage, display, and annotation functions that radiologists had until then performed on film. Initially, they were clunky and in many ways, inefficient to use. And it wasn’t until several years after that initial digital transition that technological improvements yielded the value-adding capabilities that have since dramatically improved capability, efficiency, and value of imaging services.

Something similar is happening to clinicians practicing in the age of EHRs. Publications from NEJM through InformationWeek have covered the issues of lack of usability, and increased administrative burden. The next frontier in Digital Health is for systems to find and deliver what you didn’t even know you were looking for. Systems that allow doctors to merge clinical experience with the technology, which is tireless and leaves no stone unturned. Further, technology that lets the less-experienced clinician benefit from the know-how of the more experienced.

To me, Digital Health means making every clinician the smartest in the room. It’s filtering the right information—organized fluidly according to the clinical concepts and complex guidelines that organize best practice—to empower clinicians to best serve our patients. Further, when Digital Health matures, the technology won’t make us think less—it allows us to think more, by thinking alongside us. For the foreseeable future, human experience, intuition and judgment will remain pillars of excellent clinical practice. Digital tools that permit us to exercise those uniquely human capabilities more effectively and efficiently are key to delivering a financially sustainable, high quality care at scale.

At MGH, our team of clinical and software experts took it upon ourselves some 7 years ago to make our EHR more useful in the clinical trench. The first application we launched reduced utilization of radiology studies by making clinicians aware of prior exams. Saving time and money for the system and avoiding unnecessary exposure for patients. Our solution also permitted a novel, powerful search across the entirety of a patient’s electronic health record and this capability “went viral”—starting in MGH, the application moved across departments and divisions of the hospital. Basic EHR search is a commodity, and our system has evolved well beyond its early capabilities to become an intelligent concept service platform, empowering workflow improvements all across a health care enterprise.

Now, when my colleagues move to other hospitals, they speak to how impossible it is to practice medicine without EHR intelligence—like suddenly being forced to navigate the Internet without Google again. Today at QPID Health, we are pushing the envelope to make it easy to find the Little Data about the patient that is essential to good care. Helping clinicians work smarter, not harder.

The reason I chose to become a physician was to help solve problems and deliver quality care—it’s immensely gratifying to contribute to a solution that allows physicians to do just that.

Dr. Mike Zalis is Co-founder and Chief Medical Officer of QPID Health, an associate professor at Harvard Medical School, and a board certified Radiologist serving part-time at Massachusetts General Hospital in Interventional Radiology. Mike’s deep knowledge of what clinicians need to practice most effectively and his ability to translate those needs into software solutions inform QPID’s development efforts. QPID software uses a scalable cloud-based architecture and leverages advanced concept-based natural language processing to extract patient insights from data stored in EHRs. QPID’s applciations support decision making at the point of care as well as population health and revenue cycle needs.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was reading some people’s comments on a LinkedIn group and it sparked this interesting question:

If you can move healthcare data wherever we want it, then will the EHR’s have to change their business model?

I think this is a really important question. I’m sure that some will question whether we’ll be able to ever move healthcare data wherever we want it. I can’t remember the exact stat, but I recently saw that a huge percentage of the granular health data is stored in lab results. We’re already moving lab result data pretty well between systems. The same can be said for eRX. We’ve kind of cracked those nuts and eventually we’ll make the rest of the data available as well.

I think the answer to the question is that EHR vendors will have to change. I’m not sure they’ll have to change their business model per se, but they will have to change. The fact that a healthcare organization could take their healthcare data and go somewhere else will mean that an EHR vendor will have to be much more accountable to the software they produce and release.

I’ve often used the comparison on my blog. It is powered by WordPress and one of the great features of WordPress is that I can export my entire blog into one file and then import it wherever I want. This makes the cost of switching from WordPress to some other blogging platform simple.

While it’s really simple for me to change, I’m fiercely loyal to WordPress. Largely because WordPress has delivered a high quality product that keeps improving in the 9 years I’ve been using it. Just because I can switch products doesn’t mean I will switch.

The same very much applies to EHR software. Plus, there are other costs that won’t be recovered if I switch. For example, training costs and configuration costs. There are certainly plenty of reasons why someone wouldn’t want to switch EHR software even if they could get their data out. In fact, I’d argue that if you’re to the point where you’re willing to go through the hassle of switching EHR software, you should do it. It’s not easy to get that uncomfortable with an EHR software that you want to go through the hassle. Although, I guess a few might be naive to the EHR switching costs.

Long story short, I think standard interfaces for EHR data wouldn’t kill the EHR business, but it would cause it to change and change for the good. I’d welcome such a change. A few EHR vendors wouldn’t, but that actually is just another reason we should make it a reality. It would be the first thing on my list if I were to create a “meaningful certification.”

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Jennifer is highlighting how challenging it is to get data out of an EHR in order to do healthcare analytics. This is certainly an issue and a challenge. Although, as much of a challenge is the integrity of the data that’s entered in the EHR.

Healthcare IT marketers and PR junkies finally have a focused conference. Just for us! Join in April if you can. http://t.co/TdiiPTgYMv

I love Beth’s description of the Health IT Marketing and PR conference we announced. It’s been interesting to see people’s reaction to the conference. So many marketing and PR people are use to going to conferences, but they’re always going there to sell their products. It seems that they’ve rarely gone to a conference where they go to learn. It’s such a change in what the word “conference” usually means to them. By the way, the conference is coming together very nicely. It’s going to be a great event.

I love the concept of a hospital without walls. This is happening. A little slower than I’d like, but we’re getting there in a lot of areas. Of course, this will never replace hospitals, but it will be a great compliment to hospitals.

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The Atrius health study, published in the Journal of General Internal Medicine, found that docs who reviewed lab test cost data decreased their ordering rates for certain tests and saved up to $107 per 1,000 per month. The study also found that lab test utilization decreased by up to 5.6 lab orders per 1,000 visits per month, HIN reported.

The study, which was led by Daniel Horn of Massachusetts General Hospital’s Division of General Medicine, surveyed 215 primary care docs at Atrius Health. Physicians in the intervention group got up-to-date information on lab costs for 27 individual tests when they placed e-orders. There was also a control group of physicians who didn’t get the information.

Researchers saw significant decreases in ordering rates for five out of 27 high and low cost lab tests, and a decrease in utilization for all 27 tests, though not all shifts were statistically significant. Meanwhile, 49 percent of doctors felt that they had enough information to make their ordering decisions.

Thomas Sequist, MD, Atrius Health director of research and co-author of the study, said these findings suggest that seeing lab data in EMRs could scale up in big ways. For example, he notes, in a large physician practice managing 20,000 visits per month, that’s $2,140 per month and more than $25,000 per year.

This isn’t the only evidence that access to lab test costs and info reduces ordering. A study published last year in the Archives of Internal Medicine concluded that during the period between January 1, 1999 and Dec. 31, 2004, during the test of a health information exchange, there was a 49 percent reduction in number of tests for patients with recent off-site tests.

That being said, other studies — such as this one appearing in Health Affairs — have found that doctors who see earlier tests and images actually tend to order more follow up tests.

It seems clear that this is an important area for further study, as needless tests are a big cost driver. In the mean time, we’ll have to make do with contradictory evidence.

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While doctors may not be completely comfortable with granting patients access to their EHR data, new evidence suggests that doing so produces significant benefits. A new study published in the Journal of Medical Internet Research has concluded that granting patients such access “overwhelmingly” yields positive results, according to a report in FierceEMR.

To track the benefits of patient data access, researchers studied the My HealtheVet EHR pilot program, which gave access to the initial PHR established by VA. The pilot recruited 7,464 patients at nine VA facilities between 2000 and 2010. An enrolled patient completing in-person identity proofing could access clinic notes, hospital discharge notes, problem lists, vital signs, medications, allergies, appointments, and laboratory and imaging test results. They could also as enter personal health data, access educational content and authorize others to access the PHR for them.

To evaluate the impact of the pilot, researchers from within and outside of the VA conducted focus group interviews at the Portland, Ore.-based VA Medical Center, which had 72 percent of pilot enrollees.

In discussing the program with patients, researchers found that they did have some negative experiences, such as reading uncomplimentary or offensive language in notes, concerns with inconsistencies in content and some technical problems with the EHR, FierceEMR reports. On the other hand, having access to their data improved patients’ communication with clinicians, coordination of care and follow-through on key items such as abnormal test results, the study found.

That being said, there are some repercussions to offering this access, researchers found. Though having access to notes and test results seems to empower patients, increase their knowledge and improve self-care, it does have an impact on how physicians practice. “While shared records may or may not impact overall clinic workload, it is likely to change providers’ work, necessitating new types of skills to communicate and partner with patients,” the authors said.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently was talking with an EHR vendor and they made the comment that having their EHR all on one database was a distinct advantage over the EHR vendors who install a new database with every new EHR install. I was intrigued by the idea and could easily see some of the benefits of an EHR vendor having all of the EHR data in one database. When you think some of the future quality programs that could come out, I think there could be some advantages there as well.

Considering this advantage, I started to think about ways that multiple database EHR vendors could level the playing field with their single EHR database comrades. One idea I had was using interoperability to level the playing field. If all the EHR vendors have access to all of the data, then not only will single database EHR vendors not have an advantage, but they’ll be at a disadvantage if they don’t work to exchange the EHR data as well.

When I think about this, it makes me wonder why multiple database EHR vendors aren’t accelerating the exchange of health information. This seems like it would be to their strategic advantage to exchange information.